1. Effective with date of service July 1, 2011, the ONLY immunization administration codes covered for Medicaid recipients in the Health Check age range, 0 through 20 years of age, are CPT 90471 through CPT 90474. 2. Claims billed with CPT immunization administration codes CPT 90460 and CPT 90461 (effective for dates of service on and after…
National Coverage Determination (NCD) for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)Today the Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination that provides for Medicare coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). The coverage is effective immediately. “This is the first time…
Cyanocobalamin (Vitamin B-12 injections, J3420) is reimbursed by Medicaid at the point of sale (without prior authorization) for dialysis patients only. However, if the patient has a diagnosis of pernicious anemia a prior authorization request may be submitted for review. REVIEW CRITERIA: (All of the following must be met) 1. Confirmed diagnosis of Pernicious Anemia 2….
The Medicaid fiscal agent completed required coding for vaccine administration codes CPT 90460, CPT 90471, and CPT 90472 for the Affordable Care Act enhanced rate. Physicians must bill the vaccine product code and the vaccine administration code to receive the full reimbursement allowed by the Affordable Care Act Primary Care rate increase. The federal rule…
Looking for information about Medicaid hospital reimbursement? Medicaid reimburses licensed, Medicaid-participating hospitals for inpatient services. The services must be provided under the direction of a licensed physician or dentist. Medicaid hospital reimbursement for inpatient hospital services include room and board, medical supplies, diagnostic and therapeutic services, use of hospital facilities, drugs and biologicals, nursing care,…
Health and Human Services (HHS) Secretary Kathleen Sebelius announced the final rule on November 01, 2012 implementing the part of the health care law that delivers higher payments to primary care physicians serving Medicaid beneficiaries. The new rule raises rates to ensure doctors are paid the same for treating Medicare and Medicaid patients and does…
Beginning August 1, 2012, reimbursement for procedure codes CPT 99201 – CPT 99215 is limited to two per month for general services. This affects the following provider types and specialties: provider types 25, 26, 29 and 30 with a specialty code of 009 (Family Practice), 011 (General Practice), 012 (Preventive Medicine), 018 (Internal Medicine), 045…
After providing a service to a dually-eligible recipient, the provider sends a claim to its Medicare carrier or intermediary. After Medicare processes the claim, it sends the provider an explanation of Medicare benefits (EOMB). If Medicare has approved the claim, Medicaid can pay towards the deductible and coinsurance according to Medicaid policy. Medicare crossover claims…
Medicare has paid the claim in an amount that equals or exceeds Medicaid’s fee for the specified service; The combined amount received from Medicare and any other third party exceeds Medicaid’s fee for the service; The Medicaid program limitations for the service have already been met for a recipient who has no Qualified Medicare Beneficiary…
Medicaid will not reimburse an attending physician for certifying the home health plan of care. This is considered as already reimbursed to the attending physician through any evaluation and management services provided throughout the period of illness that the recipient is receiving home health care assistance. CPT G0179 CPT G0180 CPT G0181 CPT G0182 CPT…